A female aged 30, presents with episodic throbbing headache for past 4 yrs. It usually involves one half of the face and is associated with nausea and vomiting. There is no aura. Most likely diagnosis is:
First, I need to recall the different types of headaches. Migraine is a common one. Classic migraine features include unilateral throbbing pain, nausea/vomiting, photophobia, phonophobia, and sometimes aura. But in this case, there's no aura mentioned. That makes me think about migraine without aura, also known as common migraine.
Cluster headaches are another possibility. They are severe, unilateral, and often around the eye, but they typically occur in clusters over weeks or months and are associated with autonomic symptoms like tearing or nasal congestion. However, cluster headaches are less common than migraines and usually affect men more than women. The patient here is female, so maybe less likely cluster.
Tension-type headaches are usually bilateral, pressing or tightening, not throbbing, and don't have nausea/vomiting. So probably not that. Trigeminal neuralgia is a sharp, electric pain, not throbbing. So that's out.
The absence of aura and presence of nausea/vomiting point towards migraine without aura. The other options don't fit as well. So the correct answer should be migraine without aura.
**Core Concept**
The question assesses the differential diagnosis of primary headache disorders, focusing on clinical features distinguishing **migraine without aura** from other types like cluster headaches or tension-type headaches. Key features include unilateral, pulsating pain with nausea/vomiting but no aura.
**Why the Correct Answer is Right**
Migraine without aura (common migraine) is characterized by unilateral, moderate-to-severe throbbing headaches lasting 4–72 hours, often accompanied by nausea, vomiting, photophobia, or phonophobia. The absence of an aura (visual, sensory, or motor symptoms preceding the headache) differentiates it from classic migraine. The described symptoms—unilateral throbbing pain, nausea/vomiting, and no aura—strongly align with this diagnosis.
**Why Each Wrong Option is Incorrect**
**Option A:** Cluster headache typically presents with severe unilateral orbital pain, autonomic symptoms (e.g., lacrimation, ptosis), and a circadian pattern (often at night), but not nausea/vomiting.
**Option B:** Tension-type headache is bilateral, pressing/tightening, and not associated with nausea/vomiting or throbbing.
**Option C:** Trigeminal neuralgia causes paroxysmal, sharp, electric-shock-like facial pain, not throbbing headaches.
**Clinical Pearl / High-Yield Fact**
Remember the **ICHD-3 criteria** for migraine: unilateral, pulsating, moderate-to-severe pain with ≥1 associated symptom (nausea/vomiting, photophobia/phonophobia). Absence of aura excludes classic migraine but supports the diagnosis of **migraine without aura**. Cluster headaches often have autonomic features and a more circadian pattern.
**Correct Answer: C. Migraine without aura**